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Finding Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources

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Finding Medicare Fee-For-Service (FFS)
September 8December 19, 2022 , 2022
Payment System Rules: Schedules and
Michele L. Malloy
Resources
Research Librarian Research Librarian

The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care
facilities based on statutorily established payment systems, most of which are updated annually facilities based on statutorily established payment systems, most of which are updated annually

through regulations. These proposed and final rules follow schedules based on requirements through regulations. These proposed and final rules follow schedules based on requirements
found in statute, regulation, or both. found in statute, regulation, or both.
As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health care facilities As Medicare FFS payment system proposed and final rules are issued, they impact payments received by health care facilities
and providers. Congressional Members and committees may comment, and are often contacted by provider and beneficiary and providers. Congressional Members and committees may comment, and are often contacted by provider and beneficiary
groups. Tracking the status and requirements for specific rules can be onerous, since they have different schedules and web groups. Tracking the status and requirements for specific rules can be onerous, since they have different schedules and web
locations. locations.
This report contains information on these payment system rules in a quick reference table. Specifically, the table compiles the This report contains information on these payment system rules in a quick reference table. Specifically, the table compiles the
payment systems, their main portals on the Centers for Medicare & Medicaid Services (CMS) website, the typical payment systems, their main portals on the Centers for Medicare & Medicaid Services (CMS) website, the typical
rulemaking schedule, statutory and regulatory requirements, and the most recently issued proposed rules, public comments, rulemaking schedule, statutory and regulatory requirements, and the most recently issued proposed rules, public comments,
final rules, and subsequent corrections. The table also includes embedded links to the applicable resources. Not all payment final rules, and subsequent corrections. The table also includes embedded links to the applicable resources. Not all payment
systems include detailed statutory and regulatory requirements, as noted in the table. systems include detailed statutory and regulatory requirements, as noted in the table.
Congressional Research Service Congressional Research Service

link to page 4 link to page 4 link to page 5 link to page 5 link to page link to page 4 link to page 4 link to page 5 link to page 5 link to page 1819 Finding Medicare Fee-For-Service (FFS) Payment System Rules

Contents
Introduction ..................................................................................................................................... 1
Medicare Fee-For-Service Payment System Rules: Schedules and Resources ............................... 1

Tables
Table 1. Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and
Resources ..................................................................................................................................... 2

Contacts
Author Information ........................................................................................................................ 1516


Congressional Research Service Congressional Research Service
link to page 5 link to page 5 Finding Medicare Fee-For-Service (FFS) Payment System Rules

Introduction
The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care
facilities based on statutorily established payment systems, most of which are updated annually facilities based on statutorily established payment systems, most of which are updated annually
through regulations. These proposed and final rules follow schedules based on requirements through regulations. These proposed and final rules follow schedules based on requirements
found in statute, regulation, or both. Medicare payment systems that follow annual regulatory found in statute, regulation, or both. Medicare payment systems that follow annual regulatory
updates with comment periods include the following: updates with comment periods include the following:
 Medicare Physician Fee Schedule Payment (MPFS or PFS),  Medicare Physician Fee Schedule Payment (MPFS or PFS),
 Hospital Outpatient Prospective Payment System (OPPS),  Hospital Outpatient Prospective Payment System (OPPS),
 Ambulatory Surgical Center Payment System (ASC Payment System),  Ambulatory Surgical Center Payment System (ASC Payment System),
 Acute Inpatient Prospective Payment System (IPPS),  Acute Inpatient Prospective Payment System (IPPS),
 Long-Term Care Hospital Prospective Payment System (LTCH PPS),  Long-Term Care Hospital Prospective Payment System (LTCH PPS),
 Skilled Nursing Facility Prospective Payment System (SNF PPS),  Skilled Nursing Facility Prospective Payment System (SNF PPS),
 Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS),  Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS),
 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS),  Inpatient Psychiatric Facility Prospective Payment System (IPF PPS),
 Home Health Prospective Payment System (Home Health PPS),  Home Health Prospective Payment System (Home Health PPS),
 End Stage Renal Disease Prospective Payment System (ESRD PPS), and  End Stage Renal Disease Prospective Payment System (ESRD PPS), and
 Hospice Wage Index and Payment Rate.  Hospice Wage Index and Payment Rate.
As Medicare FFS payment system proposed and final rules are issued, they impact payments As Medicare FFS payment system proposed and final rules are issued, they impact payments
received by health care facilities and providers. Congressional Members and committees may received by health care facilities and providers. Congressional Members and committees may
comment, and are often contacted by provider and beneficiary groups. Tracking the status and comment, and are often contacted by provider and beneficiary groups. Tracking the status and
requirements for specific rules can be onerous, because they have different schedules and web requirements for specific rules can be onerous, because they have different schedules and web
locations. This report contains information on these payment system rules in a quick reference locations. This report contains information on these payment system rules in a quick reference
table. table.
To learn more about these payment systems, please see applicable sections of CRS Report To learn more about these payment systems, please see applicable sections of CRS Report
R40425, R40425, Medicare Primer. In addition, the Medicare Payment Advisory Commission (MedPAC) . In addition, the Medicare Payment Advisory Commission (MedPAC)
produces Payment Basics,1 a series of brief overviews of how Medicare’s payment systems produces Payment Basics,1 a series of brief overviews of how Medicare’s payment systems
function. function.
Medicare Fee-For-Service Payment System Rules:
Schedules and Resources
Medicare FFS payment system rules and the associated statutory and regulatory requirements Medicare FFS payment system rules and the associated statutory and regulatory requirements
regarding timeline and public comment can be difficult to regarding timeline and public comment can be difficult to locatelocate. Table 1 compiles the payment compiles the payment
systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the systems; their main portals on the Centers for Medicare & Medicaid Services (CMS) website; the
typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued typical rulemaking schedule; statutory and regulatory requirements; and the most recently issued
proposed and final rules, including agency docket numbers, proposed and final rules, including agency docket numbers, Federal Register citations, public citations, public
comments available on Regulations.gov, and any corrections issued. The table also includes comments available on Regulations.gov, and any corrections issued. The table also includes
embedded links to the applicable resources and notes when rulemaking timelines and comment embedded links to the applicable resources and notes when rulemaking timelines and comment
periods are not specified. Not all payment systems include detailed statutory and regulatory periods are not specified. Not all payment systems include detailed statutory and regulatory
requirements, as noted in the table. requirements, as noted in the table.

1 MedPAC, 1 MedPAC, Payment Basics, at , at http://https://www.medpac.gov/medpac.gov/-documents-document-type/payment-/payment-basicsbasic/. .
Congressional Research Service Congressional Research Service

1 1
link to page link to page 1718
Table 1. Medicare Fee-For-Service (FFS) Payment System Rules: Schedules and Resources

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Payment Policies Under the July-August November Payment Policies Under the July-August November
42 USC §1395w-4: Payment for 42 USC §1395w-4: Payment for
N/A N/A
2023 ProposedFinal Rule
Physician Fee Schedule Physician Fee Schedule
physicians’ services physicians’ services
( (7/2911/18/2022) CMS-1770-/2022) CMS-1770-PF

(b)(1) “Before November 1 of (b)(1) “Before November 1 of
87 FR 87 FR 4586069404
Medicare Physician Fee Medicare Physician Fee
the preceding year, for each year the preceding year, for each year
Comments: Regulations.gov
Schedule Payment (PFS) Schedule Payment (PFS)
beginning with 1998, subject to beginning with 1998, subject to
subsection (p), the Secretary subsection (p), the Secretary
CMS-2022-01132023 Proposed Rule
shall establish, by regulation, fee shall establish, by regulation, fee
(7/29/2022) CMS-1770-P
schedules that establish payment schedules that establish payment
2022 Final Rule87 FR 45860
amounts for all physicians' amounts for all physicians'
services furnished in all fee services furnished in all fee
(11/19/2021) CMS-1751-FComments: Regulations.gov
schedule areas (as defined in schedule areas (as defined in
86 FR 64996CMS-2022-0113
subsection (j)(2)) for the year." subsection (j)(2)) for the year."


2022 ProposedFinal Rule
Note: Public comment is not Note: Public comment is not
( (7/2311/19/2021) CMS-1751-/2021) CMS-1751-PF
addressed broadly for PFS in addressed broadly for PFS in
statute. However, public statute. However, public
86 FR 86 FR 3910464996
comment is addressed for comment is addressed for
Comments: Regulations.gov
aspects of the physician payment aspects of the physician payment
CMS-2021-01192022 Proposed Rule
system, such as the development system, such as the development
(7/23/2021) CMS-1751-P
of categories and codes. of categories and codes.
86 FR 39104 Comments: Regulations.gov CMS-2021-0119 2021 Final Rule
(12/28/2020) CMS-1734-F (12/28/2020) CMS-1734-F
85 FR 84472 85 FR 84472
Corrections: 86 FR 5020 Corrections: 86 FR 5020
(1/19/2021) and 86 FR 14690 (1/19/2021) and 86 FR 14690
(3/18/2021) (3/18/2021)

2021 Proposed Rule
(8/17/2020) CMS-1734-P
85 FR 50074
CRS-2 CRS-2
link to page link to page 1718

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2021 Proposed Rule (8/17/2020) CMS-1734-P 85 FR 50074 Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0088 CMS-2020-0088

2020 Final Rule
(11/15/2019) CMS-1715-F (11/15/2019) CMS-1715-F
84 FR 62568 84 FR 62568

2020 Proposed Rule
(8/14/2019) CMS-1715-P (8/14/2019) CMS-1715-P
84 FR 40482 84 FR 40482
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0111 CMS-2019-0111
Hospital Outpatient Hospital Outpatient
July-August November July-August November
42 USC §1395l: Payment of 42 USC §1395l: Payment of
42 CFR §419.50 Annual review. 42 CFR §419.50 Annual review.
2023 ProposedFinal Rule
Prospective Payment and Prospective Payment and
-December benefits -December benefits

( (7/2611/23/2022) CMS-1772-/2022) CMS-1772-PFC
Ambulatory Surgical Ambulatory Surgical
(t) Prospective payment system (t) Prospective payment system
Center Payment Systems Center Payment Systems
42 CFR §416.130 Publication of revised 42 CFR §416.130 Publication of revised
87 FR 87 FR 4450271748
for hospital outpatient for hospital outpatient
payment methodologies. payment methodologies.

department services department services
Comments: Regulations.gov
"Whenever CMS proposes to revise the "Whenever CMS proposes to revise the
Hospital Outpatient Hospital Outpatient

CMS-2022-01182023 Proposed Rule
payment rate for ASCs, CMS publishes a notice payment rate for ASCs, CMS publishes a notice
Prospective Payment Prospective Payment
Note: Specific timelines for Note: Specific timelines for
in the Federal Register describing the revision. in the Federal Register describing the revision.
(7/26/2022) CMS-1772-P
System (OPPS) System (OPPS)
rulemaking and comments are rulemaking and comments are
The notice also explains the basis on which the The notice also explains the basis on which the
2022 Final Rule87 FR 44502

not addressed in statute. not addressed in statute.
rates were established. After reviewing public rates were established. After reviewing public
(11/16/2021) CMS-1753-FCComments: Regulations.gov
Ambulatory Surgical Ambulatory Surgical

comments, CMS publishes a notice establishing comments, CMS publishes a notice establishing
86 FR 63458CMS-2022-0118
Center (ASC) Payment Center (ASC) Payment
the rates authorized by this section. In setting the rates authorized by this section. In setting
42 USC §1395l: Payment of 42 USC §1395l: Payment of

System System
these rates, CMS may adopt reasonable these rates, CMS may adopt reasonable
benefits benefits
classifications of facilities and may establish classifications of facilities and may establish
2022 ProposedFinal Rule
(i) Outpatient surgery (i) Outpatient surgery
different rates for different types of surgical different rates for different types of surgical
( (8/411/16/2021) CMS-1753-/2021) CMS-1753-PFC
“Taking into account the “Taking into account the
procedures." procedures."
86 FR 86 FR 4201863458
recommendations in the report recommendations in the report
under section 626(d) of
Comments: Regulations.gov
Medicare Prescription Drug,
CMS-2021-0124
Improvement, and Modernization

Act of 2003, the Secretary shall
CRS-3
link to page 17 CRS-3 link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
implement a revised payment
2021 Final Rule
system for payment of surgical
(12/29/2020) CMS-1736-FC
services furnished in ambulatory
surgical centers."
85 FR 85866

Corrections: 86 FR 11428
(2/25/2021)
Note: Specific timelines for
rulemaking and comments

under section 626(d) of Medicare Prescription Drug, 2022 Proposed Rule Improvement, and Modernization Act of 2003, the Secretary shall (8/4/2021) CMS-1753-P implement a revised payment 86 FR 42018 system for payment of surgical Comments: Regulations.gov services furnished in ambulatory CMS-2021-0124 surgical centers." 2021 Final Rule Note: Specific timelines for (12/29/2020) CMS-1736-FC rulemaking and comments beyond the initial year are not 85 FR 85866beyond the initial year are not
2021 Proposed Rule
addressed in statute. addressed in statute.
Corrections: 86 FR 11428 (2/25/2021) 2021 Proposed Rule (8/12/2020) CMS-1736-P (8/12/2020) CMS-1736-P
85 FR 48772 85 FR 48772
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0090 CMS-2020-0090

2020 Final Rule
(11/27/2019) CMS-1717-F2 (11/27/2019) CMS-1717-F2
84 FR 65524 84 FR 65524

2020 Proposed Rule
(8/9/2019) CMS-1717-P (8/9/2019) CMS-1717-P
84 FR 39398 84 FR 39398
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0109 CMS-2019-0109
CRS-4 link to page 18 Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Payment System(s)a Rule Final Rule Statutory Regulatory Issued Rule(s) Hospital Inpatient Hospital Inpatient
April-May April-May
August- August-
42 USC §1395ww: Payments to 42 USC §1395ww: Payments to
42 CFR §412.8 Publication of schedules for 42 CFR §412.8 Publication of schedules for
2023 Final Rule
Prospective Payment Prospective Payment
October October
hospitals for inpatient hospital hospitals for inpatient hospital
determining prospective payment rates. determining prospective payment rates.
(8/10/2022) CMS-1771-F (8/10/2022) CMS-1771-F
Systems for Acute Care Systems for Acute Care
services services
"(b) Annual publication of schedule for "(b) Annual publication of schedule for
Hospitals and the Long- Hospitals and the Long-
87 FR 48780 87 FR 48780
(e)(1)(C)(5) (e)(1)(C)(5)
determining prospective payment rates. (1) determining prospective payment rates. (1)
Term Care Hospital Term Care Hospital
CMS proposes changes in the methods, CMS proposes changes in the methods,

Prospective Payment Prospective Payment
“The Secretary shall cause to “The Secretary shall cause to
amounts, and factors used to determine amounts, and factors used to determine
2023 Proposed Rule
System System
have published in the Federal have published in the Federal
Register, not later than- (A) the Register, not later than- (A) the
inpatient prospective payment rates in a inpatient prospective payment rates in a
(5/10/2022) CMS-1771-P (5/10/2022) CMS-1771-P

April 1 before each fiscal year April 1 before each fiscal year
Federal Register document published for public Federal Register document published for public
87 FR 28108 87 FR 28108 Acute Inpatient
(beginning with fiscal year 1986), (beginning with fiscal year 1986),
comment not later than the April 1 before the comment not later than the April 1 before the
CRS-4
link to page 17

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Acute InpatientComments: Regulations.gov Prospective Payment
the Secretary’s proposed the Secretary’s proposed
beginning of the Federal fiscal year in which the beginning of the Federal fiscal year in which the
Comments: Regulations.gov
Prospective Payment
CMS-2022-0074 System (IPPS) recommendations under recommendations under
proposed changes would apply. proposed changes would apply.
CMS-2022-0074
System (IPPS)
paragraph (4) for that fiscal year paragraph (4) for that fiscal year
(2) Except as provided in paragraph (c) of this (2) Except as provided in paragraph (c) of this


for public comment, and (B) the for public comment, and (B) the
section, CMS publishes a Federal Register section, CMS publishes a Federal Register
August 1 before such fiscal year
2022 Final Rule
Long-Term Care Hospital Long-Term Care Hospital
August 1 before such fiscal year document setting forth final methods, amounts, document setting forth final methods, amounts,
after such consideration of publicProspective Payment
(8/13/2021) CMS-1752-F (8/13/2021) CMS-1752-F
Prospective Payment
after such consideration of public and factors for determining inpatientand factors for determining inpatient System (LTCH PPS)
comment on the proposal as is comment on the proposal as is
System (LTCH PPS)
prospective payment rates not later than the prospective payment rates not later than the
86 FR 44774 86 FR 44774
feasible in the time available, the feasible in the time available, the
August 1 before the Federal fiscal year in which August 1 before the Federal fiscal year in which

Secretary's final Secretary's final
the rates would apply." the rates would apply."
recommendations under such
2022 Proposed Rule
paragraph for that year."recommendations under such

(5/10/2021) CMS-1752-P (5/10/2021) CMS-1752-P

paragraph for that year." 42 CFR §412.535 Publication of the Federal 42 CFR §412.535 Publication of the Federal
86 FR 25070 86 FR 25070
prospective payment rates. prospective payment rates.
Corrections: 86 FR 33157 42 USC §1395ww: Payments to42 USC §1395ww: Payments to
Corrections: 86 FR 33157
hospitals for inpatient hospital
"Except as specified in paragraph (b), CMS "Except as specified in paragraph (b), CMS
(6/24/2021) (6/24/2021)
serviceshospitals for inpatient hospital
publishes information pertaining to the long- publishes information pertaining to the long-
services Comments: Regulations.gov term care hospital prospective payment system term care hospital prospective payment system
Comments: Regulations.govCMS-2021-0070
(m) Prospective payment for (m) Prospective payment for
effective for each annual update in the Federal effective for each annual update in the Federal
CMS-2021-0070
long-term care hospitals long-term care hospitals
Register. Register.


(c) For the period beginning on or after (c) For the period beginning on or after
2021 Final Rule
Note: Specific timelines for Note: Specific timelines for
October 1, 2009, information on the October 1, 2009, information on the
(9/18/2020) CMS-1735-F (9/18/2020) CMS-1735-F
rulemaking and comments for rulemaking and comments for
unadjusted Federal payment rates and a unadjusted Federal payment rates and a 85 FR 58432
Long-Term Care Hospital PPS Long-Term Care Hospital PPS
description of the methodology and data used description of the methodology and data used
Corrections: 85 FR 7874885 FR 58432
are not addressed in statute. are not addressed in statute.
to calculate the payment rates are published on to calculate the payment rates are published on
Corrections: 85 FR 78748
or before August 1 prior to the start of the or before August 1 prior to the start of the
(12/7/2020) (12/7/2020)
Federal fiscal year which begins October 1, Federal fiscal year which begins October 1,

CRS-5 link to page 18 Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Payment System(s)a Rule Final Rule Statutory Regulatory Issued Rule(s) unless for good cause it is published after unless for good cause it is published after
2021 Proposed Rule
August 1, but before September 1. August 1, but before September 1.
(5/29/2020) CMS-1735-P (5/29/2020) CMS-1735-P
(d) Information on the LTC-DRG classification (d) Information on the LTC-DRG classification
85 FR 32460 and associated weighting factors is published onand associated weighting factors is published on 85 FR 32460
or before August 1 prior to the beginning of or before August 1 prior to the beginning of
Comments: Regulations.gov Comments: Regulations.gov
each Federal fiscal year." each Federal fiscal year."
CMS-2020-0052 CMS-2020-0052

2020 Final Rule
(8/16/2019) CMS-1716-F (8/16/2019) CMS-1716-F
CRS-5
link to page 17

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
84 FR 42044 84 FR 42044

2020 Proposed Rule
(5/3/2019) CMS-1716-P(5/3/2019) CMS-1716-P
84 FR 19158 84 FR 19158
Corrections: 84 FR 28263 Corrections: 84 FR 28263
(6/18/2019) (6/18/2019)
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0073 CMS-2019-0073
Prospective Payment Prospective Payment
April-May April-May
August August
42 USC §1395yy: Payment to 42 USC §1395yy: Payment to
42 CFR §413.345 Publication of Federal 42 CFR §413.345 Publication of Federal
2023 Final Rule
System and Consolidated System and Consolidated
skilledskil ed nursing facilities for nursing facilities for
prospective payment rates. prospective payment rates.
(8/3/2022) CMS-1765-F (8/3/2022) CMS-1765-F
Billing for SkilledBil ing for Skil ed Nursing Nursing
routine service costs routine service costs
"CMS publishes information pertaining to each "CMS publishes information pertaining to each
Facilities (SNF) Facilities (SNF)
87 FR 47502 87 FR 47502
(e)(4)(H) (e)(4)(H)
update of the Federal payment rates in the update of the Federal payment rates in the


“The Secretary shall provide for “The Secretary shall provide for
Federal Register. This information includes the Federal Register. This information includes the
SkilledSkil ed Nursing Facility Nursing Facility
publication in the Federal publication in the Federal
standardized Federal rates, the resident standardized Federal rates, the resident
2023 Proposed Rule
Prospective Payment Prospective Payment
Register, before May 1, 1998 Register, before May 1, 1998
classification system that provides the basis for classification system that provides the basis for
(4/15/2022) CMS-1765-P (4/15/2022) CMS-1765-P
System (SNF PPS) System (SNF PPS)
(with respect to fiscal period (with respect to fiscal period
case-mix adjustment, and the factors to be case-mix adjustment, and the factors to be
87 FR 22720 87 FR 22720
described in subparagraph (E)(i)) described in subparagraph (E)(i))
applied in making the area wage adjustment. applied in making the area wage adjustment.
Comments: Regulations.gov Comments: Regulations.gov
and before the August 1 and before the August 1
This information is published before May 1 for This information is published before May 1 for
preceding each succeeding fiscal preceding each succeeding fiscal
the fiscal year 1998 and before August 1 for the CMS-2022-0069 the fiscal year 1998 and before August 1 for the CMS-2022-0069
year (with respect to that year (with respect to that
fiscal years 1999 and after." fiscal years 1999 and after."

succeeding fiscal year), of- succeeding fiscal year), of-
2022 Final Rule
CRS-6 link to page 18 Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Payment System(s)a Rule Final Rule Statutory Regulatory Issued Rule(s) (i) the unadjusted Federal per (i) the unadjusted Federal per
(8/4/2021) CMS-1746-F (8/4/2021) CMS-1746-F
diem rates to be applied to days diem rates to be applied to days
86 FR 42424 of covered of covered skilledskil ed nursing facility nursing facility
86 FR 42424
services furnished during the services furnished during the

fiscal year, fiscal year,
2022 Proposed Rule
( (iii ) the case mix classification ) the case mix classification
(4/15/2021) CMS- 1746-P (4/15/2021) CMS- 1746-P
system to be applied under system to be applied under
86 FR 19954 86 FR 19954
subparagraph (G)(i) with respect subparagraph (G)(i) with respect
to such services during the fiscal
Comments: Regulations.gov
year, and
CMS-2021-0062
CRS-6
link to page 17

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
(iii Comments: Regulations.gov to such services during the fiscal CMS-2021-0062 year, and (i i) the factors to be applied in ) the factors to be applied in

making the area wage adjustment making the area wage adjustment
2021 Final Rule
under subparagraph (G)( under subparagraph (G)(ii) with
respect to such services."
i ) with (8/5/2020) CMS-1737-F (8/5/2020) CMS-1737-F

respect to such services." 85 FR 47594 85 FR 47594
Note: The timeline for the Note: The timeline for the

2021 Proposed Rule proposed rule and comments are proposed rule and comments are
2021 Proposed Rule
not addressed in statute. not addressed in statute.
(4/15/2020) CMS-1737-P (4/15/2020) CMS-1737-P
85 FR 20914 85 FR 20914
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0036 CMS-2020-0036

2020 Final Rule
(8/7/2019) CMS-1718-F (8/7/2019) CMS-1718-F
84 FR 38728 84 FR 38728

2020 Proposed Rule
(4/25/2019) CMS-1718-P (4/25/2019) CMS-1718-P
84 FR 17620 84 FR 17620
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0070CMS-2019-0070 CRS-7 link to page 18 Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Payment System(s)a Rule Final Rule Statutory Regulatory Issued Rule(s)
Inpatient Rehabilitation Inpatient Rehabilitation
April-May April-May
August August
42 USC §1395ww: Payments to 42 USC §1395ww: Payments to
42 CFR §412.628 Publication of the Federal 42 CFR §412.628 Publication of the Federal
2023 Final Rule
Facility Prospective Facility Prospective
hospitals for inpatient hospital hospitals for inpatient hospital
prospective payment rates. prospective payment rates.
(8/1/2022) CMS-1767-F (8/1/2022) CMS-1767-F
Payment System Payment System
services services
"We publish information pertaining to the "We publish information pertaining to the
87 FR 47038 87 FR 47038

(j)(5) (j)(5)
inpatient rehabilitation facility prospective inpatient rehabilitation facility prospective

Inpatient Rehabilitation Inpatient Rehabilitation
“The Secretary shall provide for “The Secretary shall provide for
payment system effective for each fiscal year in payment system effective for each fiscal year in
Facility Prospective Facility Prospective
publication in the Federal publication in the Federal
the Federal Register. This information includes the Federal Register. This information includes
2023 Proposed Rule
Payment System (IRF PPS) Payment System (IRF PPS)
Register, on or before August 1 Register, on or before August 1
the unadjusted Federal payment rates, the the unadjusted Federal payment rates, the
(4/6/2022) CMS-1767-P (4/6/2022) CMS-1767-P
before each fiscal year (beginning before each fiscal year (beginning
patient classification system and associated patient classification system and associated
87 FR 20218 87 FR 20218
with fiscal year 2001), of the with fiscal year 2001), of the
weighting factors, and a description of the weighting factors, and a description of the
Comments: Regulations.gov Comments: Regulations.gov
classification and weighting classification and weighting
methodology and data used to calculate the methodology and data used to calculate the
CRS-7
link to page 17

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
factors for case mix groups factors for case mix groups
payment rates. This information is published on payment rates. This information is published on
CMS-2022-0061 CMS-2022-0061
under paragraph (2) for such under paragraph (2) for such
or before August 1 prior to the beginning of or before August 1 prior to the beginning of

fiscal year and a description of fiscal year and a description of
each fiscal year." each fiscal year."
2022 Final Rule the methodology and data used the methodology and data used
2022 Final Rule
in computing the prospective in computing the prospective
(8/4/2021) CMS-1748-F (8/4/2021) CMS-1748-F
payment rates under this payment rates under this
86 FR 42362 86 FR 42362
subsection for that fiscal year." subsection for that fiscal year."


2022 Proposed Rule
Note: Only the final rule Note: Only the final rule
(4/12/2021) CMS-1748-P (4/12/2021) CMS-1748-P
deadline is specified, the deadline is specified, the
86 FR 19086 proposed rule is not addressed proposed rule is not addressed
86 FR 19086
in statute. Public comment is not in statute. Public comment is not
Comments: Regulations.gov Comments: Regulations.gov
addressed in statute. addressed in statute.
CMS-2021-0057 CMS-2021-0057

2021 Final Rule
(8/10/2020) CMS-1729-F (8/10/2020) CMS-1729-F
85 FR 48424 85 FR 48424

2021 Proposed Rule
(4/21/2020) CMS-1729-P (4/21/2020) CMS-1729-P
85 FR 2206585 FR 22065
Comments: Regulations.gov
CMS-2020-0039

2020 Final Rule
(8/8/2019) CMS-1710-F
84 FR 39054

2020 Proposed Rule
(4/24/2019) CMS-1710-P
CRS-8
link to page 17 CRS-8 link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
Comments: Regulations.gov CMS-2020-0039 2020 Final Rule (8/8/2019) CMS-1710-F 84 FR 39054 2020 Proposed Rule (4/24/2019) CMS-1710-P 84 FR 17244 84 FR 17244
Corrections: 84 FR 24734 Corrections: 84 FR 24734
(5/29/2019) (5/29/2019)
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0066 CMS-2019-0066
Inpatient Psychiatric Inpatient Psychiatric
April-May April-May
August August
42 USC §1395ww: Payments to 42 USC §1395ww: Payments to
42 CFR §412.428 Publication of changes to the 42 CFR §412.428 Publication of changes to the
2023 Final Rule
Facilities Prospective Facilities Prospective
hospitals for inpatient hospital hospitals for inpatient hospital
inpatient psychiatric facility prospective inpatient psychiatric facility prospective
(7/29/2022) CMS-1769-F (7/29/2022) CMS-1769-F
Payment System Payment System
services services
payment system. payment system.
87 FR 46846 87 FR 46846

(s) Prospective payment for (s) Prospective payment for
“CMS “CMS will wil issue annually in the Federal Register issue annually in the Federal Register

Inpatient Psychiatric Facility Inpatient Psychiatric Facility
psychiatric hospitals psychiatric hospitals
information pertaining to changes to the information pertaining to changes to the
Prospective Payment Prospective Payment

inpatient psychiatric facility prospective inpatient psychiatric facility prospective
2023 Proposed Rule
System (IPF PPS) System (IPF PPS)
payment system." payment system."
Note: specific timelines for Note: specific timelines for
(4/4/2022) CMS-1769-P (4/4/2022) CMS-1769-P
rulemaking and comments for rulemaking and comments for
87 FR 19415 87 FR 19415
Inpatient Psychiatric Facility PPS Inpatient Psychiatric Facility PPS
Comments: Regulations.gov Comments: Regulations.gov
are not addressed in statute. are not addressed in statute.
CMS-2022-0062 CMS-2022-0062
Deadlines for quality measures Deadlines for quality measures
are specified. are specified.

2022 Final Rule
(8/4/2021) CMS-1750-F (8/4/2021) CMS-1750-F
86 FR 42608 86 FR 42608

2022 Proposed Rule
(4/13/2021) CMS-1750-P
86 FR 19480
Comments: Regulations.gov
CMS-2021-0060

2021 Final Rule
(8/4/2020) CMS-1731-F
85 FR 47042
CRS-9
link to page 17 link to page 17 CRS-9 link to page 18

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2022 Proposed Rule (4/13/2021) CMS-1750-P 86 FR 19480 Comments: Regulations.gov CMS-2021-0060 2021 Final Rule (8/4/2020) CMS-1731-F 85 FR 47042 Corrections: 85 FR 52923 Corrections: 85 FR 52923
(8/27/2020) (8/27/2020)

2021 Proposed Rule
(4/14/2020) CMS-1731-P (4/14/2020) CMS-1731-P
85 FR 20625 85 FR 20625
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0035 CMS-2020-0035

2020 Final Rule
(8/6/2019) CMS-1712-F(8/6/2019) CMS-1712-F
84 FR 38424 84 FR 38424

2020 Proposed Rule
(4/23/2019) CMS-1712-P (4/23/2019) CMS-1712-P
84 FR 16948 84 FR 16948
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0067 CMS-2019-0067
CRS-10 link to page 18 link to page 18 Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Payment System(s)a Rule Final Rule Statutory Regulatory Issued Rule(s) Home Health Prospective Home Health Prospective
July July
November November
42 USC §1395fff: Prospective 42 USC §1395fff: Prospective
42 CFR §484.225 Annual update of the 42 CFR §484.225 Annual update of the
2023 ProposedFinal Rule
Payment System Payment System
payment for home health payment for home health
unadjusted national, standardized prospective unadjusted national, standardized prospective
( (6/2311/4/2022) CMS-1766-/2022) CMS-1766-PF

services services
payment rates. payment rates.
87 FR 87 FR 3760066790
Home Health Prospective Home Health Prospective

“CMS annually updates the unadjusted national, “CMS annually updates the unadjusted national,
Comments: Regulations.gov
Payment System (Home Payment System (Home
Note: Specific timelines for Note: Specific timelines for
standardized prospective payment rate on a standardized prospective payment rate on a
Health PPS) Health PPS)
rulemaking and comments for rulemaking and comments for
calendar year basis (in accordance with section calendar year basis (in accordance with section
CMS-2022-01092023 Proposed Rule
Home Health PPS are not Home Health PPS are not
1895(b)(1)(B) of the 1895(b)(1)(B) of the Act).Act)."b (6/23/2022) CMS-1766-P addressed in statute. 87 FR 37600 Comments: Regulations.gov CMS-2022-0109 2022 Final Rule (11/9/2021) CMS-1747-F 86 FR 62240 2022 Proposed Rule (7/7/2021) CMS-1747-P 86 FR 35874 Comments: Regulations.gov CMS-2021-0112 2021 Final Rule (11/4/2020) CMS-1730-F 85 FR 70298 2021 Proposed Rule (6/30/2020) CMS-1730-P 85 FR 39408 CRS-11 link to page 18"b

addressed in statute.
2022 Final Rule
(11/9/2021) CMS-1747-F
86 FR 62240

CRS-10
link to page 17

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2022 Proposed Rule
(7/7/2021) CMS-1747-P
86 FR 35874
Comments: Regulations.gov
CMS-2021-0112

2021 Final Rule
(11/4/2020) CMS-1730-F
85 FR 70298

2021 Proposed Rule
(6/30/2020) CMS-1730-P
85 FR 39408
Corrections: 85 FR 43805 Corrections: 85 FR 43805
(7/20/2020) (7/20/2020)
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0077 CMS-2020-0077

2020 Final Rule
(11/8/2019) CMS-1711-FC(11/8/2019) CMS-1711-FC
84 FR 60478 84 FR 60478

2020 Proposed Rule
(7/18/2019) CMS-1711-P(7/18/2019) CMS-1711-P
84 FR 34598 84 FR 34598
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0100 CMS-2019-0100
CRS-11
link to page 17

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System(s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
End-Stage Renal Disease End-Stage Renal Disease
July July
November November
42 USC §1395rr: End stage renal 42 USC §1395rr: End stage renal
42 CFR §413.196 Notification of changes in 42 CFR §413.196 Notification of changes in
2023 ProposedFinal Rule
Prospective Payment Prospective Payment
disease program disease program
rate-setting methodologies and payment rates. rate-setting methodologies and payment rates.
( (6/2811/7/2022) CMS-1768-/2022) CMS-1768-PF
System System

“(b) Changes in payment rates resulting from “(b) Changes in payment rates resulting from
87 FR 87 FR 3846467136

Note: Specific timelines for Note: Specific timelines for
incorporation of updated cost data or general incorporation of updated cost data or general
Comments: Regulations.gov
End Stage Renal Disease End Stage Renal Disease
rulemaking and comments for rulemaking and comments for
revisions of geographic labor cost adjustment revisions of geographic labor cost adjustment
Prospective Payment Prospective Payment
ESRD PPS are not addressed in ESRD PPS are not addressed in
factors are announced by notice published in factors are announced by notice published in
CMS-2022-01102023 Proposed Rule
System (ESRD PPS) System (ESRD PPS)
statute. statute.
the Federal Register without opportunity for the Federal Register without opportunity for
(6/28/2022) CMS-1768-P
prior comment. Revisions of the rate-setting prior comment. Revisions of the rate-setting
2022 Final Rule87 FR 38464
methodology are published in the Federal methodology are published in the Federal
Register in accordance with the Department’s Register in accordance with the Department’s
(11/8/2021) CMS-1749-F
established rulemaking procedures."
86 FR 61874
Comments: Regulations.gov established rulemaking procedures." CMS-2022-0110 2022 Final Rule (11/8/2021) CMS-1749-F 86 FR 61874 CRS-12 link to page 18 Typically Issued Requirements: Timeline and Public Comment Rule Name and Proposed Most Recently Payment System(s)a Rule Final Rule Statutory Regulatory Issued Rule(s) Corrections: 86 FR 70982 Corrections: 86 FR 70982
(12/14/2021) (12/14/2021)

2022 Proposed Rule
(7/9/2021) CMS-1749-P (7/9/2021) CMS-1749-P
86 FR 36322 86 FR 36322
Comments: Regulations.gov Comments: Regulations.gov
CMS-2021-0114 CMS-2021-0114

2021 Final Rule
(11/9/2020) CMS-1732-F (11/9/2020) CMS-1732-F
85 FR 71398 85 FR 71398

2021 Proposed Rule
(7/13/2020) CMS-1732-P (7/13/2020) CMS-1732-P
85 FR 42132 85 FR 42132
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0079 CMS-2020-0079

2020 Final Rule (11/8/2019) CMS-1713-F 84 FR 60648 2020 Proposed Rule (8/6/2019) CMS-1713-P 84 FR 38330 Comments: Regulations.gov CMS-2019-0110 CRS-13 CRS-12
link to page link to page 1718 link to page link to page 1718

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)
2020 Final Rule
(11/8/2019) CMS-1713-F
84 FR 60648

2020 Proposed Rule
(8/6/2019) CMS-1713-P
84 FR 38330
Comments: Regulations.gov
CMS-2019-0110
Hospice Wage Index and Hospice Wage Index and
April-May April-May
August August
42 USC §1395f: Conditions of 42 USC §1395f: Conditions of
42 CFR §418.306 Annual update of the 42 CFR §418.306 Annual update of the
2023 Final Rule
Payment Rate Payment Rate
and limitations on payment for and limitations on payment for
payment rates and adjustment for area wage payment rates and adjustment for area wage
(7/29/2022) CMS-1773-F (7/29/2022) CMS-1773-F

services services
differences. differences.
87 FR 45669 87 FR 45669
Hospice Wage Index and Hospice Wage Index and
(i) Payment for hospice care (i) Payment for hospice care
“(b) Annual update of the payment rates. The “(b) Annual update of the payment rates. The

Payment Rate Payment Rate

payment rates for routine home care and other payment rates for routine home care and other
services included in hospice care are the services included in hospice care are the
2023 Proposed Rule
Note: Specific timelines for Note: Specific timelines for
payment rates in effect under this paragraph payment rates in effect under this paragraph
rulemaking and comments for rulemaking and comments for
(4/4/2022) CMS-1773-P (4/4/2022) CMS-1773-P
during the previous fiscal year increased by the during the previous fiscal year increased by the
hospice payment rates are not hospice payment rates are not
87 FR 19442 87 FR 19442
hospice payment update percentage increase hospice payment update percentage increase
addressed in statute. addressed in statute.
(as defined in sections1814(i)(1)(C) of the Act), (as defined in sections1814(i)(1)(C) of the Act),
Comments: Regulations.gov Comments: Regulations.gov
applicable to discharges occurring in the fiscal applicable to discharges occurring in the fiscal
CMS-2022-0060 CMS-2022-0060
year."b

2022 Final Rule
(8/4/2021) CMS-1754-F (8/4/2021) CMS-1754-F
86 FR 42528 86 FR 42528

2022 Proposed Rule
(4/14/2021) CMS-1754-P (4/14/2021) CMS-1754-P
86 FR 19700 86 FR 19700
Comments: Regulations.gov Comments: Regulations.gov
CMS-2021-0061CMS-2021-0061 2021 Final Rule (8/4/2020) CMS-1733-F 85 FR 47070 2021 Proposed Rule (4/15/2020) CMS-1733-P 85 FR 20949 CRS-14
CRS-13
link to page link to page 1718

Typically Issued
Requirements: Timeline and Public Comment

Rule Name and
Proposed
Most Recently
Payment System((s)a
Rule
Final Rule
Statutory
Regulatory
Issued Rule(s)

2021 Final Rule
(8/4/2020) CMS-1733-F
85 FR 47070

2021 Proposed Rule
(4/15/2020) CMS-1733-P
85 FR 20949
Comments: Regulations.gov Comments: Regulations.gov
CMS-2020-0037 CMS-2020-0037

2020 Final Rule
(8/6/2019) CMS-1714-F (8/6/2019) CMS-1714-F
84 FR 38484 84 FR 38484

2020 Proposed Rule
(4/25/2019) CMS-1714-P (4/25/2019) CMS-1714-P
84 FR 17570 84 FR 17570
Comments: Regulations.gov Comments: Regulations.gov
CMS-2019-0068 CMS-2019-0068
Source: Compiled by the Congressional Research Service (CRS). Compiled by the Congressional Research Service (CRS).
Notes: Table compiled using Centers for Medicare & Medicaid Services (CMS) websites, Table compiled using Centers for Medicare & Medicaid Services (CMS) websites, Federal Register, and Regulations.gov. In some cases, although multiple payment , and Regulations.gov. In some cases, although multiple payment
systems are covered by one rule, they are combined here in one row but listed separately. Typical months when proposed and final rules are issued can vary, and the systems are covered by one rule, they are combined here in one row but listed separately. Typical months when proposed and final rules are issued can vary, and the
months we list are based on CRS analysis of Federal Register publication dates from the past 10 years. Additionally, corrections are sometimes issued after the final rule. months we list are based on CRS analysis of Federal Register publication dates from the past 10 years. Additionally, corrections are sometimes issued after the final rule.
a. Some Medicare FFS payment systems are not updated through notice and comment or on an annual basis, but only periodically. These include Clinical Laboratory a. Some Medicare FFS payment systems are not updated through notice and comment or on an annual basis, but only periodically. These include Clinical Laboratory
Fee Schedule, Shared Savings Program, and Ambulance Fee Schedule. Please see the embedded CMS links for more information, including the most recent rules. Fee Schedule, Shared Savings Program, and Ambulance Fee Schedule. Please see the embedded CMS links for more information, including the most recent rules.
b. At times, regulations reference the Social Security Act rather than the b. At times, regulations reference the Social Security Act rather than the U.S. Code citation. The Social Security Administration provides a cross-reference table at citation. The Social Security Administration provides a cross-reference table at
https://www.ssa.gov/OP_Home/comp2/G-APP-H.html. https://www.ssa.gov/OP_Home/comp2/G-APP-H.html.
CRS- CRS-1415
Finding Medicare Fee-For-Service (FFS) Payment System Rules



Author Information

Michele L. Malloy Michele L. Malloy

Research Librarian Research Librarian


Acknowledgments
CRS Analysts Jim Hahn, Marco Villagrana, and Phoenix Voorhies aided in the compilation and review of CRS Analysts Jim Hahn, Marco Villagrana, and Phoenix Voorhies aided in the compilation and review of
the statutory and regulatory requirements of selected payment system rules. the statutory and regulatory requirements of selected payment system rules.

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material. copy or otherwise use copyrighted material.

Congressional Research Service Congressional Research Service
R46797 R46797 · VERSION 810 · UPDATED
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